Systemic lupus erythematosus CT: Difference between revisions

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Latest revision as of 16:20, 1 February 2018

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1] Associate Editor(s)-in-Chief: Mahshid Mir, M.D. [2]

Overview

On abdominal CT-scan, systemic lupus erythematosus (SLE) may be characterized by hepatosplenomegaly, pancreatic parenchymal enlargement, and ascites. On cardiac CT-scan, SLE may be characterized by enhancement of the thickened pericardium. On brain CT-scan, SLE may be characterized by brain atrophy, stroke patterns like cortical hypodensity, and increased attenuation of the cortex.

Key CT Findings in Systemic Lupus Erythematosus

On CT-scan, systemic lupus erythematosus (SLE) may be characterized by the following features, based on the organ system involvement:^[1]^[2]^[3]^[4]^[5]^[6]^[7]^[8]^[9]^[10]^[11]

More common complications

Organ	Disease	CT	Preview
Gastrointestinal	Hepatitis	Nonspecific, ranging from normal to hepatomegaly and cirrhosis May present hepatic granulomas Discrete, sharply defined nodular lesions within the liver	Adapted from Radiopaedia
Gastrointestinal	Mesenteric vasculitis	Ascites Fluid in the abdomen Dilated bowel Mural thickening Abnormal wall enhancement Mesentric vessel engorgement Comb sign: Hypervascular appearance of the mesentery Linear densities on the mesenteric side of the affected segments of small bowel, which lead to the appearance of the teeth of a comb	Adapted from Radiopaedia
Kidney	Nephritis	Heterogeneous enlarged kidneys Mostly illustrate the rim of normal density tissue Wedge shaped areas of low density	Adapted from Radiopaedia
Pulmonary	Pleural effusion	May be associated with thickening of the pleura Fluid density	Adapted from Radiopaedia
	Pulmonary hypertension	ECG-gated CT pulmonary angiography Right ventricular hypertrophy: defined as wall thickness of >4 mm Straightening or bowing (towards the left ventricle) of the interventricular septum Right ventricular dilatation (a right ventricle to left ventricle diameter ratio of more than 1:1 at the midventricular level on axial images) Decreased right ventricular ejection fraction Ancillary features Dilatation of the inferior vena cava and hepatic veins Pericardial effusion Enlarged pulmonary trunk (measured at pulmonary artery bifurcation on an axial slice vertical to its long axis) Enlarged pulmonary arteries Mural calcification in central pulmonary arteries Centrilobular ground-glass nodules Neovascularization Tiny serpiginous intrapulmonary vessels that often emerge from centrilobular arterioles but do not conform to usual pulmonary arterial anatomy	Adapted from Radiopaedia
	Pneumonitis	Unilateral or bilateral patchy and focal consolidation typically in the lung bases May accompany pleural effusion	Adapted from Radiopaedia
Neurological	Genreral	Brain atrophy May be due to steroid therapy or age

Less common complications

Organ	Disease	CT	Preview
Gastrointestinal	Intestinal pseudo-obstruction	Dilated bowel loops with or without the presence of fluid levels A distinct transition point where bowel calibre changes from normal to abnormal Dilated bowel loops proximal to the transition point: Small bowel >3.5 cm Large bowel >5 cm Collapsed or normal calibre bowel distal to the transitional point Bowel wall thickening Obstruction: Pneumoperitoneum indicating perforation Bowel ischaemia	Adapted from Radiopaedia
	Acute pancreatitis	Abnormalities that may be seen in the pancreas include: Typical findings Focal or diffuse parenchymal enlargement Changes in density because of edema Indistinct pancreatic margins owing to inflammation Mesenteric fatty infiltration around the pancreas Liquefactive necrosis of pancreatic parenchyma Lack of parenchymal enhancement Often multifocal Abscess formation Circumscribed fluid collection Little or no necrotic tissues (thus distinguishing it from infected necrosis) Phlegmon formation Haemorrhage High-attenuation fluid in the retroperitoneum or peripancreatic tissues	Adapted from Radiopaedia
	Autosplenectomy	Abnormally small and irregular splenic remnant May show calcified spleen	Adapted from Radiopaedia
	Acute cholecystitis	Gallbladder distension Gallbladder wall thickening Mural or mucosal hyperenhancement Pericholecystic fluid and inflammatory fat stranding Enhancement of the adjacent liver parenchyma due to reactive hyperaemia Tensile gallbladder fundus sign Fundus bulging the anterior abdominal wall	Adapted from Radiopaedia
Pulmonary	Pulmonary emboli	Filling defects within the pulmonary vasculature with acute pulmonary emboli Vascular CT signs include Direct pulmonary artery signs Complete obstruction Partial obstruction Eccentric thrombus Calcified thrombus- calcific pulmonary emboli Pulmonary arterial bands Post stenotic dilatation Signs related to pulmonary hypertension Enlargement of main pulmonary arteries Narrowing of the peripheral pulmonary arteries in affected segments Pulmonary arterial calcification Tortuous pulmonary vessels Right ventricular hypertrophy Signs of systemic collateral supply Enlargement of bronchial and nonbronchial systemic arteries Parenchymal signs (often non-specific on their own) Scars Mosaic perfusion pattern Focal ground-glass opacities Bronchial anomalies	Adapted from Radiopaedia
	Shrinking lung syndrome	Reduced lung volumes with diaphragmatic elevation Occasional basal atelectasis No major parenchymal lung or pleural disease
	Pulmonary fibrosis	Honeycombing Fibrotic cystic changes Traction bronchiectasis Dilatation of bronchi and bronchioles within fibrotic lung tissue Lung architectural distortion Reticulation Interlobular septal thickening	Adapted from Radiopaedia
Cardiac	Acute pericarditis	Enhancement of the thickened pericardium	Adapted from Radiopaedia
Cardiac	Pericardial effusion	Fluid density material surrounding the heart	Adapted from Radiopaedia
Neurological	Stroke	Early sign A hyperdense segment of a vessel, representing direct visualization of the intravascular thrombus Early hyperacute Loss of grey-white matter differentiation Hypoattenuation of deep nuclei Cortical hypodensity with associated parenchymal swelling with resultant gyral effacement Elevation of the attenuation of the cortex	Adapted from Radiopaedia

References

↑ Appenzeller S (2013). "Magnetic resonance imaging in systemic lupus erythematosus: where do we stand?". Cogn Behav Neurol. 26 (2): 53–4. doi:10.1097/WNN.0b013e31829d5b60. PMID 23812167.
↑ Thurman JM, Serkova NJ (2015). "Non-invasive imaging to monitor lupus nephritis and neuropsychiatric systemic lupus erythematosus". F1000Res. 4: 153. doi:10.12688/f1000research.6587.2. PMC 4536614. PMID 26309728.
↑ Lin K, Lloyd-Jones DM, Li D, Liu Y, Yang J, Markl M, Carr JC (2015). "Imaging of cardiovascular complications in patients with systemic lupus erythematosus". Lupus. 24 (11): 1126–34. doi:10.1177/0961203315588577. PMC 4567427. PMID 26038342.
↑ Sarbu N, Bargalló N, Cervera R (2015). "Advanced and Conventional Magnetic Resonance Imaging in Neuropsychiatric Lupus". F1000Res. 4: 162. doi:10.12688/f1000research.6522.2. PMC 4505788. PMID 26236469.
↑ Qin H, Guo Q, Shen N, Huang X, Wu H, Zhang M, Bao C, Chen S (2014). "Chest imaging manifestations in lupus nephritis". Clin. Rheumatol. 33 (6): 817–23. doi:10.1007/s10067-014-2586-2. PMID 24696368.
↑ Goh YP, Naidoo P, Ngian GS (2013). "Imaging of systemic lupus erythematosus. Part II: gastrointestinal, renal, and musculoskeletal manifestations". Clin Radiol. 68 (2): 192–202. doi:10.1016/j.crad.2012.06.109. PMID 22901453.
↑ Gal Y, Twig G, Mozes O, Greenberg G, Hoffmann C, Shoenfeld Y (2013). "Central nervous system involvement in systemic lupus erythematosus: an imaging challenge". Isr. Med. Assoc. J. 15 (7): 382–6. PMID 23943987.
↑ Shirato M, Hisa N, Fujikura Y, Ohkuma K, Kutsuki S, Hiramatsu K (1992). "[Imaging diagnosis of lupus enteritis--especially about sonographic findings]". Nihon Igaku Hoshasen Gakkai Zasshi (in Japanese). 52 (10): 1394–9. PMID 1448334.
↑ Adachi JD, Lau A (2014). "Systemic lupus erythematosus, osteoporosis, and fractures". J. Rheumatol. 41 (10): 1913–5. doi:10.3899/jrheum.140919. PMID 25275093.
↑ Curiel R, Akin EA, Beaulieu G, DePalma L, Hashefi M (2011). "PET/CT imaging in systemic lupus erythematosus". Ann. N. Y. Acad. Sci. 1228: 71–80. doi:10.1111/j.1749-6632.2011.06076.x. PMID 21718325.
↑ Goh YP, Naidoo P, Ngian GS (2013). "Imaging of systemic lupus erythematosus. Part I: CNS, cardiovascular, and thoracic manifestations". Clin Radiol. 68 (2): 181–91. doi:10.1016/j.crad.2012.06.110. PMID 22901452.

Template:WH Template:WS

[pmid23812167-1] Appenzeller S (2013). "Magnetic resonance imaging in systemic lupus erythematosus: where do we stand?". Cogn Behav Neurol. 26 (2): 53–4. doi:10.1097/WNN.0b013e31829d5b60. PMID 23812167.

[pmid26309728-2] Thurman JM, Serkova NJ (2015). "Non-invasive imaging to monitor lupus nephritis and neuropsychiatric systemic lupus erythematosus". F1000Res. 4: 153. doi:10.12688/f1000research.6587.2. PMC 4536614. PMID 26309728.

[pmid26038342-3] Lin K, Lloyd-Jones DM, Li D, Liu Y, Yang J, Markl M, Carr JC (2015). "Imaging of cardiovascular complications in patients with systemic lupus erythematosus". Lupus. 24 (11): 1126–34. doi:10.1177/0961203315588577. PMC 4567427. PMID 26038342.

[pmid26236469-4] Sarbu N, Bargalló N, Cervera R (2015). "Advanced and Conventional Magnetic Resonance Imaging in Neuropsychiatric Lupus". F1000Res. 4: 162. doi:10.12688/f1000research.6522.2. PMC 4505788. PMID 26236469.

[pmid24696368-5] Qin H, Guo Q, Shen N, Huang X, Wu H, Zhang M, Bao C, Chen S (2014). "Chest imaging manifestations in lupus nephritis". Clin. Rheumatol. 33 (6): 817–23. doi:10.1007/s10067-014-2586-2. PMID 24696368.

[pmid22901453-6] Goh YP, Naidoo P, Ngian GS (2013). "Imaging of systemic lupus erythematosus. Part II: gastrointestinal, renal, and musculoskeletal manifestations". Clin Radiol. 68 (2): 192–202. doi:10.1016/j.crad.2012.06.109. PMID 22901453.

[pmid23943987-7] Gal Y, Twig G, Mozes O, Greenberg G, Hoffmann C, Shoenfeld Y (2013). "Central nervous system involvement in systemic lupus erythematosus: an imaging challenge". Isr. Med. Assoc. J. 15 (7): 382–6. PMID 23943987.

[pmid1448334-8] Shirato M, Hisa N, Fujikura Y, Ohkuma K, Kutsuki S, Hiramatsu K (1992). "[Imaging diagnosis of lupus enteritis--especially about sonographic findings]". Nihon Igaku Hoshasen Gakkai Zasshi (in Japanese). 52 (10): 1394–9. PMID 1448334.

[pmid25275093-9] Adachi JD, Lau A (2014). "Systemic lupus erythematosus, osteoporosis, and fractures". J. Rheumatol. 41 (10): 1913–5. doi:10.3899/jrheum.140919. PMID 25275093.

[pmid21718325-10] Curiel R, Akin EA, Beaulieu G, DePalma L, Hashefi M (2011). "PET/CT imaging in systemic lupus erythematosus". Ann. N. Y. Acad. Sci. 1228: 71–80. doi:10.1111/j.1749-6632.2011.06076.x. PMID 21718325.

[pmid22901452-11] Goh YP, Naidoo P, Ngian GS (2013). "Imaging of systemic lupus erythematosus. Part I: CNS, cardiovascular, and thoracic manifestations". Clin Radiol. 68 (2): 181–91. doi:10.1016/j.crad.2012.06.110. PMID 22901452.

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@@ Line 1: / Line 1: @@
 __NOTOC__
 {{Systemic lupus erythematosus}}
-{{CMG}}
+{{CMG}} {{AE}} {{MIR}}
 ==Overview==
+On abdominal [[CT-scans|CT-scan]], systemic lupus erythematosus (SLE) may be characterized by [[hepatosplenomegaly]], [[pancreatic]] parenchymal enlargement, and [[ascites]]. On cardiac [[CT-scans|CT-scan]], SLE may be characterized by enhancement of the thickened [[pericardium]]. On brain [[Computed tomography|CT-scan,]] SLE may be characterized by [[brain atrophy]], stroke patterns like [[Cortical area|cortical]] hypodensity, and increased [[attenuation]] of the [[Cerebral cortex|cortex]].
-=== Pulmonary ===
+== Key CT Findings in Systemic Lupus Erythematosus ==
+On [[CT-scans|CT-scan]], systemic lupus erythematosus (SLE) may be characterized by the following features, based on the organ system involvement:<ref name="pmid23812167">{{cite journal |vauthors=Appenzeller S |title=Magnetic resonance imaging in systemic lupus erythematosus: where do we stand? |journal=Cogn Behav Neurol |volume=26 |issue=2 |pages=53–4 |year=2013 |pmid=23812167 |doi=10.1097/WNN.0b013e31829d5b60 |url=}}</ref><ref name="pmid26309728">{{cite journal |vauthors=Thurman JM, Serkova NJ |title=Non-invasive imaging to monitor lupus nephritis and neuropsychiatric systemic lupus erythematosus |journal=F1000Res |volume=4 |issue= |pages=153 |year=2015 |pmid=26309728 |pmc=4536614 |doi=10.12688/f1000research.6587.2 |url=}}</ref><ref name="pmid26038342">{{cite journal |vauthors=Lin K, Lloyd-Jones DM, Li D, Liu Y, Yang J, Markl M, Carr JC |title=Imaging of cardiovascular complications in patients with systemic lupus erythematosus |journal=Lupus |volume=24 |issue=11 |pages=1126–34 |year=2015 |pmid=26038342 |pmc=4567427 |doi=10.1177/0961203315588577 |url=}}</ref><ref name="pmid26236469">{{cite journal |vauthors=Sarbu N, Bargalló N, Cervera R |title=Advanced and Conventional Magnetic Resonance Imaging in Neuropsychiatric Lupus |journal=F1000Res |volume=4 |issue= |pages=162 |year=2015 |pmid=26236469 |pmc=4505788 |doi=10.12688/f1000research.6522.2 |url=}}</ref><ref name="pmid24696368">{{cite journal |vauthors=Qin H, Guo Q, Shen N, Huang X, Wu H, Zhang M, Bao C, Chen S |title=Chest imaging manifestations in lupus nephritis |journal=Clin. Rheumatol. |volume=33 |issue=6 |pages=817–23 |year=2014 |pmid=24696368 |doi=10.1007/s10067-014-2586-2 |url=}}</ref><ref name="pmid22901453">{{cite journal |vauthors=Goh YP, Naidoo P, Ngian GS |title=Imaging of systemic lupus erythematosus. Part II: gastrointestinal, renal, and musculoskeletal manifestations |journal=Clin Radiol |volume=68 |issue=2 |pages=192–202 |year=2013 |pmid=22901453 |doi=10.1016/j.crad.2012.06.109 |url=}}</ref><ref name="pmid23943987">{{cite journal |vauthors=Gal Y, Twig G, Mozes O, Greenberg G, Hoffmann C, Shoenfeld Y |title=Central nervous system involvement in systemic lupus erythematosus: an imaging challenge |journal=Isr. Med. Assoc. J. |volume=15 |issue=7 |pages=382–6 |year=2013 |pmid=23943987 |doi= |url=}}</ref><ref name="pmid1448334">{{cite journal |vauthors=Shirato M, Hisa N, Fujikura Y, Ohkuma K, Kutsuki S, Hiramatsu K |title=[Imaging diagnosis of lupus enteritis--especially about sonographic findings] |language=Japanese |journal=Nihon Igaku Hoshasen Gakkai Zasshi |volume=52 |issue=10 |pages=1394–9 |year=1992 |pmid=1448334 |doi= |url=}}</ref><ref name="pmid25275093">{{cite journal |vauthors=Adachi JD, Lau A |title=Systemic lupus erythematosus, osteoporosis, and fractures |journal=J. Rheumatol. |volume=41 |issue=10 |pages=1913–5 |year=2014 |pmid=25275093 |doi=10.3899/jrheum.140919 |url=}}</ref><ref name="pmid21718325">{{cite journal |vauthors=Curiel R, Akin EA, Beaulieu G, DePalma L, Hashefi M |title=PET/CT imaging in systemic lupus erythematosus |journal=Ann. N. Y. Acad. Sci. |volume=1228 |issue= |pages=71–80 |year=2011 |pmid=21718325 |doi=10.1111/j.1749-6632.2011.06076.x |url=}}</ref><ref name="pmid22901452">{{cite journal |vauthors=Goh YP, Naidoo P, Ngian GS |title=Imaging of systemic lupus erythematosus. Part I: CNS, cardiovascular, and thoracic manifestations |journal=Clin Radiol |volume=68 |issue=2 |pages=181–91 |year=2013 |pmid=22901452 |doi=10.1016/j.crad.2012.06.110 |url=}}</ref>
-====== Pulmonary hypertension (right ventricular prominence, or loud P2) ======
+=== More common complications ===
-* ECG-gated CT pulmonary angiography shows:
+{| class="wikitable"
+! style="background: #4479BA; color: #FFFFFF; " |Organ
-** Right ventricular hypertrophy: defined as wall thickness of >4 mm
+! style="background: #4479BA; color: #FFFFFF; " |Disease
-** Straightening or bowing (towards the left ventricle) of the interventricular septum
+! style="background: #4479BA; color: #FFFFFF; " |CT
-** Right ventricular dilatation (a right ventricle–to–left ventricle diameter ratio of more than 1:1 at the midventricular level on axial images)
+! style="background: #4479BA; color: #FFFFFF; " |Preview
-** Decreased right ventricular ejection fraction
+|-
+| rowspan="2" style="background: #DCDCDC; " align="center" |<small><small>[[Gastrointestinal]]</small></small>
+![[Hepatitis]]
+|
+* Nonspecific, ranging from normal to [[hepatomegaly]] and [[cirrhosis]]
+* May present hepatic [[granulomas]]
+** Discrete, sharply defined [[nodular lesions]] within the [[liver]]
+|
+[[File:Webp.net-gifmaker (13).gif|thumb|300px|<SMALL><SMALL>''[https://radiopaedia.org/  Adapted from Radiopaedia]''</SMALL></SMALL>]]
+|-
+![[Mesenteric vascular occlusion|Mesenteric vasculitis]]
+|
+* [[Ascites]]
+** Fluid in the [[abdomen]]
+* Dilated bowel
+* Mural thickening
+* Abnormal wall enhancement
+* [[Mesentery|Mesentric]] vessel engorgement
+* Comb sign:
+** Hypervascular appearance of the [[mesentery]]
+** Linear densities on the [[mesenteric]] side of the affected segments of [[small bowel]], which lead to the appearance of the teeth of a comb
+|
+[[File:Webp.net-gifmaker (15).gif|thumb|300px|<SMALL><SMALL>''[https://radiopaedia.org/  Adapted from Radiopaedia]''</SMALL></SMALL>]]
+|-
+| style="background: #DCDCDC; " align="center" |<small><small>[[Kidney]]</small></small>
+![[Nephritis]]
+|
+* Heterogeneous enlarged kidneys
+* Mostly illustrate the rim of normal density tissue
+* Wedge shaped areas of low density
+|
+[[File:Webp.net-gifmaker (16).gif|thumb|300px|<SMALL><SMALL>''[https://radiopaedia.org/  Adapted from Radiopaedia]''</SMALL></SMALL>]]
+|-
+| rowspan="3" style="background: #DCDCDC; " align="center" |<small><small>[[Pulmonary]]</small></small>
+![[Pleural effusion]]
+|
+* May be associated with [[Pleural Fibrosis|thickening of the pleura]]
+* Fluid density
+|
+[[File:Webp.net-gifmaker (17).gif|thumb|300px|<SMALL><SMALL>''[https://radiopaedia.org/  Adapted from Radiopaedia]''</SMALL></SMALL>]]
+|-
+![[Pulmonary hypertension]]
+|
+* ECG-gated CT [[pulmonary angiography]]
+** [[Right ventricular hypertrophy]]: defined as wall thickness of >4 mm
+** Straightening or bowing (towards the [[left ventricle]]) of the [[interventricular septum]]
+** [[Right ventricle|Right ventricular]] dilatation (a [[right ventricle]] to [[left ventricle]] diameter ratio of more than 1:1 at the midventricular level on axial images)
+** Decreased [[right ventricular]] [[ejection fraction]]
 ** Ancillary features
-*** dilatation of the inferior vena cava and hepatic veins
+*** Dilatation of the [[inferior vena cava]] and [[hepatic veins]]
-*** pericardial effusion
+*** [[Pericardial effusion]]
+* Enlarged [[pulmonary trunk]] (measured at [[Pulmonary artery|pulmonary artery bifurcation]] on an axial slice vertical to its long axis)
+* Enlarged [[pulmonary arteries]]
+* Mural calcification in central [[pulmonary arteries]]
+* Centrilobular ground-glass [[nodules]]
+* [[Neovascularization]]
+** Tiny serpiginous intrapulmonary vessels that often emerge from centrilobular [[arterioles]] but do not conform to usual [[Pulmonary artery|pulmonary arterial anatomy]]
+|
+[[File:Pulmonary-arterial-hypertension-7.jpg|thumb|300px|<SMALL><SMALL>''[https://radiopaedia.org/  Adapted from Radiopaedia]''</SMALL></SMALL>]]
+|-
+![[Pneumonitis]]
+|
+* Unilateral or bilateral patchy and focal [[Consolidation (medicine)|consolidation]] typically in the lung bases
+* May accompany [[pleural effusion]]
+|
+[[File:Webp.net-gifmaker (19).gif|thumb|300px|<SMALL><SMALL>''[https://radiopaedia.org/  Adapted from Radiopaedia]''</SMALL></SMALL>]]
+|-
+| style="background: #DCDCDC; " align="center" |<small><small>[[Neurological]]</small></small>
+!Genreral
+|
+* [[Brain atrophy]]
+* May be due to [[steroid therapy]] or age
+|
+|}
-* Enlarged pulmonary trunk (measured at pulmonary artery bifurcation on an axial slice vertical to its long axis)
+=== Less common complications ===
+{| class="wikitable"
-* Enlarged pulmonary arteries
+! style="background: #4479BA; color: #FFFFFF; " |Organ
-* Mural calcification in central pulmonary arteries
+! style="background: #4479BA; color: #FFFFFF; " |Disease
-* Centrilobular ground-glass nodules
+! style="background: #4479BA; color: #FFFFFF; " |CT
-* Neovascularity: tiny serpiginous intrapulmonary vessels that often emerge from centrilobular arterioles but do not conform to usual pulmonary arterial anatomy
+! style="background: #4479BA; color: #FFFFFF; " |Preview
+|-
-==== Pulmonary fibrosis ====
+| rowspan="4" style="background: #DCDCDC; " align="center" |<small><small>[[Gastrointestinal]]</small></small>
-* Honeycombing: Fibrotic cystic changes
+![[Intestinal pseudo-obstruction]]
-* Traction bronchiectasis: Dilatation of bronchi and bronchioles within fibrotic lung tissue
+|
+* Dilated bowel loops with or without the presence of fluid levels
+** A distinct transition point where bowel calibre changes from normal to abnormal
+** Dilated bowel loops [[proximal]] to the transition point:
+*** [[Small bowel]] >3.5 cm
+*** [[Large bowel]] >5 cm
+** Collapsed or normal calibre [[bowel]] distal to the transitional point
+** Bowel wall thickening
+** [[Intestinal obstruction|Obstruction]]:
+*** [[Pneumoperitoneum]] indicating [[perforation]]
+*** [[Bowel ischaemia]]
+|
+[[File:Webp.net-gifmaker (20).gif|thumb|300px|<SMALL><SMALL>''[https://radiopaedia.org/  Adapted from Radiopaedia]''</SMALL></SMALL>]]
+|-
+![[Acute pancreatitis]]
+|Abnormalities that may be seen in the [[pancreas]] include:
+* Typical findings
+** Focal or diffuse parenchymal enlargement
+** Changes in density because of [[edema]]
+** Indistinct [[Pancreas|pancreatic]] margins owing to inflammation
+** [[Mesentery|Mesenteric]] fatty infiltration around the [[pancreas]]
+* [[Liquefactive necrosis]] of pancreatic parenchyma
+** Lack of parenchymal enhancement
+** Often multifocal
+* [[Abscess of pancreas|Abscess]] formation
+** Circumscribed fluid collection
+** Little or no [[Necrotic tissue|necrotic tissues]] (thus distinguishing it from infected necrosis)
+** [[Phlegmon]] formation
+* [[Haemorrhage]]
+** High-attenuation fluid in the [[retroperitoneum]] or peripancreatic tissues
+|
+[[File:Webp.net-gifmaker (21).gif|thumb|300px|<SMALL><SMALL>''[https://radiopaedia.org/  Adapted from Radiopaedia]''</SMALL></SMALL>]]
+|-
+![[Autosplenectomy]]
+|
+* Abnormally small and irregular [[Spleen|splenic]] remnant
+* May show [[Calcification|calcified]] [[spleen]]
+|
+[[File:Webp.net-gifmaker (22).gif|thumb|300px|<SMALL><SMALL>''[https://radiopaedia.org/  Adapted from Radiopaedia]''</SMALL></SMALL>]]
+|-
+![[Acute cholecystitis]]
+|
+* [[Gallbladder]] distension
+* [[Gallbladder]] wall thickening
+* [[Mural thrombus|Mural]] or mucosal hyperenhancement
+* Pericholecystic fluid and inflammatory fat stranding
+* Enhancement of the adjacent liver parenchyma due to reactive [[hyperaemia]]
+* Tensile [[Gallbladder|gallbladder fundus]] sign
+** Fundus bulging the [[anterior abdominal wall]]
+|
+[[File:Webp.net-gifmaker (23).gif|thumb|300px|<SMALL><SMALL>''[https://radiopaedia.org/  Adapted from Radiopaedia]''</SMALL></SMALL>]]
+|-
+| rowspan="3" style="background: #DCDCDC; " align="center" |<small><small>[[Pulmonary]]</small></small>
+![[Pulmonary emboli]]
+|
+* Filling defects within the [[pulmonary vasculature]] with acute [[pulmonary emboli]]
+* Vascular CT signs include
+** Direct [[pulmonary artery]] signs
+*** Complete [[obstruction]]
+*** Partial obstruction
+*** Eccentric [[thrombus]]
+*** Calcified [[thrombus]]- calcific pulmonary emboli
+*** [[Pulmonary artery|Pulmonary arterial]] bands
+*** Post stenotic dilatation
+** Signs related to [[pulmonary hypertension]]
+*** Enlargement of main [[pulmonary arteries]]
+*** Narrowing of the [[Pulmonary arteries|peripheral pulmonary arteries]] in affected segments
+*** [[Pulmonary hypertension|Pulmonary arterial]] [[calcification]]
+*** Tortuous [[pulmonary vessels]]
+*** [[Right ventricular hypertrophy]]
+** Signs of systemic collateral supply
+*** Enlargement of [[Bronchial artery|bronchial]] and nonbronchial systemic arteries
+* Parenchymal signs (often non-specific on their own)
+** [[Scars]]
+** Mosaic [[perfusion]] pattern
+** Focal ground-glass opacities
+** [[Bronchial]] anomalies
+|
+[[File:Webp.net-gifmaker (24).gif|thumb|300px|<SMALL><SMALL>''[https://radiopaedia.org/  Adapted from Radiopaedia]''</SMALL></SMALL>]]
+|-
+!Shrinking lung syndrome
+|
+* Reduced [[lung volumes]] with [[diaphragmatic elevation]]
+* Occasional basal [[atelectasis]]
+* No major [[Interstitial lung disease|parenchymal lung]] or [[pleural disease]]
+|
+|-
+![[Pulmonary fibrosis]]
+|
+* Honeycombing
+** Fibrotic cystic changes
+* Traction [[bronchiectasis]]
+** Dilatation of [[bronchi]] and [[bronchioles]] within fibrotic lung tissue
 * Lung architectural distortion
 * Reticulation
 * Interlobular septal thickening
+|
-===== Shrinking lung =====
+[[File:Webp.net-gifmaker (25).gif|thumb|300px|<SMALL><SMALL>''[https://radiopaedia.org/  Adapted from Radiopaedia]''</SMALL></SMALL>]]
-* Reduced lung volumes with diaphragmatic elevation +/- occasional basal atelectasis but without any major parenchymal lung or pleural disease
+|-
-* Pulmonary infarction
+| rowspan="2" style="background: #DCDCDC; " align="center" |<small><small>[[Cardiac]]</small></small>
-* Wedge-shaped (less often rounded) juxtapleural opacification (Hampton hump) without air bronchograms
+![[Acute pericarditis]]
-* Consolidation with an specific pattern called  "bubbly consolidation" that is the co-existing non-infarcted lung parenchyma side-by-side with infarcted lung in the same lobule
+|
-* Cavitation
+* Enhancement of the thickened [[pericardium]]
+|
-===== Pneumonitis =====
+[[File:Webp.net-gifmaker (26).gif|thumb|300px|<SMALL><SMALL>''[https://radiopaedia.org/  Adapted from Radiopaedia]''</SMALL></SMALL>]]
-unilateral or bilateral patchy and focal consolidation typically in the lung bases
+|-
+![[Pericardial effusion]]
-accompanying pleural effusion may be present
+|
+* Fluid density material surrounding the [[heart]]
-=== Cardiac ===
+|
+[[File:Webp.net-gifmaker (27).gif|thumb|300px|<SMALL><SMALL>''[https://radiopaedia.org/  Adapted from Radiopaedia]''</SMALL></SMALL>]]
-===== Pericarditis =====
+|-
-Noncalcified pericardial thickening with pericardial effusion is suggestive of acute pericarditis
+| style="background: #DCDCDC; " align="center" |<small><small>[[Neurological]]</small></small>
+![[Stroke]]
-Cardiomyopathy (ventricular dysfunction)
+|
+* Early sign
-Valvular disease (diastolic murmur, or systolic murmur >3/6)
+** A hyperdense segment of a [[vessel]], representing direct [[Visualization (cam)|visualization]] of the [[Intravascular coagulation|intravascular thrombus]]
+* Early hyperacute
-===== Pericarditis =====
+** Loss of grey-white matter differentiation
-Abnormal thickening and enhancement of the pericardium as well as a pericardial effusion in contrast-enhanced chest CT
+** Hypoattenuation of deep nuclei
+** Cortical hypodensity with associated [[Parenchyma|parenchymal]] swelling with resultant gyral effacement
-===== neurology =====
+** Elevation of the attenuation of the [[cortex]]
-CT scans are useful for detecting structural and focal abnormalities (such as infarcts/hypodense areas, hemorrhage, tumors, cerebral calcification, abscess, and basilar meningitis) [38]. Brain atrophy has been noted in some patients; this finding has been thought by some (but disputed by others) to reflect the effects of steroid therapy [6] or age [4]. We have seen brain atrophy out of proportion to a patient's age, and prior to steroid therapy.
+|
+[[File:Webp.net-gifmaker (28).gif|thumb|300px|<SMALL><SMALL>''[https://radiopaedia.org/  Adapted from Radiopaedia]''</SMALL></SMALL>]]
-Abdominal computed tomography (CT) scan fi ndings compatible with mesenteric vasculitis include prominence of mesenteric vessels with a comb-like appearance supplying dilated bowel loops, small bowel thickening and ascites.  Excessive fatty infi ltration (steatosis) in liver/
+|}
-=== Gastrointestinal ===
-===== Pancreatitis =====
-* Peripancreatic edema
-* Phlegmon formation
-* Mesenteric fatty infiltration around the pancreas
-* Glandular enlargement
-===== Bowel ischemia due to  mesentric vascuitis =====
-* Ascites
-* Dilated bowel
-* Mural thickening
-* Abnormal wall enhancement
-* Mesentric vessel engorgement
-===== Liver and spleen ischemia =====
-* Small, peripheral, wedge-shaped areas of low attenuation that represent ischemic areas
-* {| class="wikitable" !Organ !Disease !Description !CT !MRI !SONO |- | rowspan="8" |Gastrointestinal system |[[Dysphagia]] |
-*Barium swallow/esophagography
-**Oesophageal stricture
-***Peptic strictures that appear as smooth, tapered narrowing in the distal esophagus
-**Esophageal dilatation | |NEW: visualization of soft tissue, more reliable timing analysis
-: 27770070 | |- |[[Intestinal pseudo-obstruction]] |
-*dilated bowel loops with or without the presence of fluid levels
-*Erect chest radiographs for perforation evaluating |
-*dilated bowel loops with or without the presence of fluid levels
-**a distinct transition point where bowel calibre changes from normal to abnormal
-**dilated bowel loops proximal to the transition point
-***small bowel >3.5 cm
-***large bowel >5 cm
-**collapsed or normal calibre bowel distal to the transitional point
-**bowel wall thickening
-**Obstruction:
-***pneumoperitoneum indicating perforation
-***bowel ischaemia | | |- |[[Hepatitis]] |
-** |
-*Hepatic granulomas
-*Nonspecific, ranging from normal to hepatomegaly and cirrhosis.
-**Discrete, sharply defined nodular lesions within the liver |
-*nodules ranging around 0.5-4.5 cm in diameter
-**'''T2:''' nonspecific, increased periportal oedema 4
-**'''MRCP:''' primary sclerosing cholangitis (PSC) should be excluded | |- |[[Acute pancreatitis]] |
-* |Abnormalities that may be seen in the pancreas include:
-*typical findings
-**focal or diffuse parenchymal enlargement
-**changes in density because of oedema
-**indistinct pancreatic margins owing to inflammation
-**surrounding retroperitoneal fat stranding
-*liquefactive necrosis of pancreatic parenchyma
-**lack of parenchymal enhancement
-**often multifocal
-*infected necrosis
-**difficult to distinguish from aseptic liquefactive necrosis
-**the presence of gas is helpful
-**FNA helpful
-*abscess formation
-**circumscribed fluid collection
-**little or no necrotic tissues (thus distinguishing it from infected necrosis)
-*haemorrhage
-**high-attenuation fluid in the retroperitoneum or peripancreatic tissues |Contrast-enhanced MR is equivalent to CT in the assessment of pancreatitis. Abnormalities that may be seen in the pancreas include:
-*typical findings
-**focal or diffuse parenchymal enlargement
-**changes in density because of oedema
-**indistinct pancreatic margins owing to inflammation
-**surrounding retroperitoneal fat stranding
-*liquefactive necrosis of pancreatic parenchyma
-**lack of parenchymal enhancement
-**often multifocal
-*infected necrosis
-**difficult to distinguish from aseptic liquefactive necrosis
-**the presence of gas is helpful
-**FNA helpful
-*abscess formation
-**circumscribed fluid collection
-**little or no necrotic tissues (thus distinguishing it from infected necrosis)
-*haemorrhage
-**high-attenuation fluid in the retroperitoneum or peripancreatic tissues |
-*to identify gallstones as a possible cause
-*diagnosis of vascular complications, e.g. thrombosis
-*identify areas of necrosis which appear as hypoechoic regions |- |Aotpsplenectomy |If heavily calcified, the splenic remnant may be visible in the left upper quadrant. |CT easily identifies the abnormally small and irregular splenic remnant, which is usually calcified. | |Ultrasound will either not be able to demonstrate a spleen at all, or identify a small irregular and shadowing nodule in the splenic bed. |- |Enteritis |The main feature of enteritis is '''small bowel wall thickening'''. Low density submucosal edema can usually be differentiated from higher density mural haemorrhage or infiltration. Dilatation or strictures may or may not be present, the later if chronic. | |. Low density submucosal edema can usually be differentiated from higher density mural haemorrhage or infiltration. Dilatation or strictures may or may not be present, the later if chronic. | |- |[[Mesenteric vascular occlusion|Mesenteric vasculitis]] |
-* |
-*The '''comb sign''' refers to the hypervascular appearance of the mesentery
-*This forms linear densities on the mesenteric side of the affected segments of small bowel, which give the appearance of the teeth of a comb. |
-*The '''comb sign''' refers to the hypervascular appearance of the mesentery
-*This forms linear densities on the mesenteric side of the affected segments of small bowel, which give the appearance of the teeth of a comb. | |- |[[Acute cholecystitis]] |
-* |
-*gallbladder distension
-*gallbladder wall thickening
-*mural or mucosal hyperenhancement
-*pericholecystic fluid and inflammatory fat stranding
-*enhancement of the adjacent liver parenchyma due to reactive hyperaemia
-*tensile gallbladder fundus sign 7
-**fundus bulging the anterior abdominal wall |MR cholangiopancreatography (MRCP) may show an impacted stone in the gallbladder neck or cystic duct as a rounded filling defect. |
-*gallbladder wall thickening (>3 mm) and pericholecystic fluid
-*Positive Murphy sign
-*gallbladder distension
-* |- | rowspan="7" |Pulmonary involvement |Pleural effusion |
-*A lateral decubitus film can visualise small amounts of fluid layering against the dependent parietal pleura.
-*PA and AP CXR:
-**blunting of the costophrenic angle
-**blunting of the cardiophrenic angle
-**fluid within the horizontal or oblique fissures
-**mediastinal shifts with large amounts of fluid |
-*May be associated with thickening of the pleura
-*Fluid density | |echo-free space between the visceral and parietal pleura |- |Respiratory muscle dysfunction |elevated hemidiaphragms at chest radiography linear atelectasis and an ill-defined juxtadiaphragmatic areas of increased opacity  Wiedemann HP, Matthay RA. ''Pulmonary manifestations of collagen vascular diseases.Clin Chest Med'' 1989; 10:677-696 | | | |- |[[Pneumonitis|Acute pneumonitis]] |
-*A rare and fulminant form of diffuse lung injury that generally occurs in previously healthy individuals and has a rapid onset with [[fever]], [[cough]], and [[Dyspnea|shortness of breath]]. |  features similar to adult respiratory distress syndrome (ARDS), which include:
-* areas with ground-glass attenuation: generally tend to be bilateral and symmetrical 10
-* traction bronchiectasis: can be seen in ~80% of cases during the course of the disease 4 and correlates with disease duration 2
-* parenchymal architectural distortion of the lung
-* air space consolidation: may have a slight predilection towards the dependent portion | | |- |[[Pulmonary hemorrhage]] |
-*Patchy bilateral and acinar areas of increased opacity, predominantly in the lower lungs
-** | | | |- |[[Pulmonary hypertension]] |
-*Elevated cardiac apex due to right ventricular hypertrophy
-*enlarged right atrium
-*prominent pulmonary outflow tract
-*enlarged pulmonary arteries
-*pruning of peripheral pulmonary vessels | | | |- |Pulmonary emboli |
-**Fleishner sign: enlarged pulmonary artery (20%)
-**Hampton hump: peripheral wedge of airspace opacity and implies lung infarction (20%)
-**Westermark sign: regional oligaemia and highest positive predictive value (10%)
-**pleural effusion (35%)
-**knuckle sign 11
-**Palla's sign17: enlarged right descending pulmonary artery |
-*filling defects within the pulmonary vasculature with acute pulmonary emboli
-*vascular CT signs include
-**direct pulmonary artery signs
-***complete obstruction
-***partial obstruction
-***eccentric thrombus
-***calcified thrombus - calcific pulmonary emboli
-***pulmonary arterial bands/pulmonary arterial webs 1,4-5
-***post stenotic dilatation
-**signs related to pulmonary hypertension
-***enlargement of main pulmonary arteries
-***the peripheral pulmonary arteries in affected segments may be narrowed ref required
-***pulmonary arterial calcification
-***tortuous pulmonary vessels
-***right ventricular enlargement/hypertrophy
-**signs of systemic collateral supply
-***enlargement of bronchial and nonbronchial systemic arteries
-*Signs of chronic obstruction: webs or bands, intimal irregularities 3/ abrupt narrowing or complete obstruction of the pulmonary arteries 3 / “pouching defects” which are defined as chronic thromboembolism organised in a concave shape that “points” toward the vessel lumen
-*
-*parenchymal signs (often non-specific on their own):
-**scars
-**mosaic perfusion pattern
-**focal ground-glass opacities
-**bronchial anomalies
-*The central filling defect from the thrombus is surrounded by a thin rim of contrast, appearing like the popular sweet, the polo mint |[[Palla's sign]]: enlarged right descending pulmonary artery | |- |Shrinking lung syndrome |
-*small but clear lungs with diaphragmatic elevation
-*basal atelectasis |
-*reduced lung volumes with diaphragmatic elevation +/- occasional basal atelectasis but without any major parenchymal lung or pleural disease | | |- | rowspan="7" |Cardiac involvement |[[Cardiomegaly]] |
-**Cardiac enlargement | | | |- |Mitral stenosis |
-**cardiomegaly
-**double right heart border (enlarged left atrium and normal right atrium)
-**prominent left atrial appendage
-**splaying of the subcarinal angle (>120 degrees) |valve thickening or leaflet fixation |
-*mitral leaflet thickening
-*reduced diastolic opening
-*abnormal valve motion toward the left ventricular outflow tract | |- |Mitral regurgitation |frontal projection
-*left atrial enlargement
-**convexity or straightening of the left atrial appendage just below the main pulmonary artery (along left heart border)
-**double density sign: the right side of the enlarged left atrium pushes into the adjacent lung and creates an addition contour superimposed over the right heart
-**elevation of the left main bronchus and splaying of the carina
-*upper zone venous enlargement due to pulmonary venous hypertension
-*left ventricular enlargement is also eventually present due to volume overload | | | |- |Acute pericarditis |
-* |enhancement of the thickened pericardium generally indicates inflammation |The normal pericardial thickness is considered 2 mm while a thickness of over 4 mm suggests a pericarditis | |- |Pericardial effuson |
-*globular enlargement of the cardiac shadow giving a water bottle configuration
-*Lateral CXR may show a vertical opaque line (pericardial fluid) separating a vertical lucent line directly behind sternum (epicardial fat) anteriorly from a similar lucent vertical lucent line (pericardial fat) posteriorly; this is known as the Oreo cookie sign
-* |Fluid density material is seen surrounding the heart |Fluid density material is seen surrounding the heart |Echocardiography is the method of choice to confirm the diagnosis, estimate the volume of fluid and most importantly assess the haemodynamic impact of the effusion |- |[[Myocarditis]] |
-* | |
-*regional or global wall motion abnormalities are common, but nonspecific (biventricular wall motion abnormality, however, is the main predictor of death or transplantation)
-*pericardial effusion is reported in ~45% (range 32-57%) of patients with myocarditis
-**regional vasodilatation and increased blood volume due to the inflammation in myocarditis causes early postcontrast enhancement | |- |[[Coronary heart disease|Coronary artery disease]] |
-* |
-*coronary CT angiography (cCTA)
-*can show the amount of stenosis | | |- | rowspan="3" |Neurological involvement |[[Cognitive-shifting|Cognitive dysfunction]] |
-*The mental status of SLE patients can be temporarily affected by multiple, transient metabolic and systemic processes | | | |- |[[Stroke]] |
-* |
-*Early sign: a hyperdense segment of a vessel, representing direct visualisation of the intravascular thrombus / embolus and as such is visible immediately
-*Early hyperacute: loss of grey-white matter differentiation, and hypoattenuation of deep nuclei
-*cortical hypodensity with associated parenchymal swelling with resultant gyral effacement
-*elevation of the attenuation of the cortex. This is known as the CT fogging phenomenon
-*a region of low density with negative mass effect. Cortical mineralisation can also sometimes be seen appearing hyperdense.
-* |
-*the affected parenchyma appears normal on other sequences, although changes in flow will be detected (occlusion on MRA) and the thromboembolism may be detected (e.g. on SWI). Slow or stagnant flow in vessels may also be detected as a loss of normal flow void and high signal
-*after 6 hours, high T2 signal will be detected | |- |[[Neuropathies]] |
-* | |
-*Optic neuritis:
-**Typically findings are most easily identified in the retrobulbar intra-orbital segment of the optic nerve, which appears swollen, with high T2 signal. High T2 signal persists and may be permanent; chronically the nerve will appear atrophied rather than swollen.  Contrast enhancement of the nerve, best seen with fat-suppressed T1 coronal images, is seen in >90% of patients if scanned within 20 days of visual loss | |- | |Autoimmune encephalitis | | |mesial temporal lobes and limbic systems, typically manifested by cortical thickening and increased T2/FLAIR signal intensity of these regions. Bilateral involvement is most common (60%), although often asymmetric Patchy areas of enhancement | |- | |Raynaud phenomen | | |contrast-enhanced MR angiography may also reveal characteristic narrowing and tapering of digital vessels |Doppler sonography: flow volume and vessel size irregularities |- | |Myositis | | |'''Intramuscular oedema''' (increased high T2/STIR signal) | |- | rowspan="4" |Musculoskeletal involvement |[[Arthritis]] |
-*soft tissue swelling of the involved joints, periarticular osteoporosis, and normal joint spaces. Carpal instability may be seen in 15% of patients
-*Symmetric involvement of interphalangeal joints is most common, showing swan neck and boutonniere deformities, subluxation with ulnar deviation at MCP joints, subluxation of the 1st metacarpophalangeal joint, a widened forefoot, and hallux valgus | |a deforming non-erosive arthropathy due to ligamentous laxity (not articular destruction) and muscle contracture  Up to 10% may have atlantoaxial subluxation/dislocation  ==== Spontaneous tendon weakening and rupture ==== | |- |[[Osteonecrosis]] ([[Avascular necrosis]]) |
-*initial minor osteopenia, followed by variable density. Gradually microfractures of the subchondral bone accumulate in the dead bone, which is unable to repair leading to the collapse of the articular surface and the crescent sign of AVN. Eventually the cortex collapses and fragments, with superimposed secondary degenerative change | |
-* diffuse oedema: oedema is not an early sign; instead, studies show that oedema occurs in advanced stages and is directly correlated with pain
-* reactive interface line is a focal serpentine low signal line with fatty centre (most common appearance and first sign on MRI)
-* double line sign: serpiginous peripheral/outer dark (sclerosis) and inner bright (granulation tissue) on T2WI is diagnostic
-* rim sign: osteochondral fragmentation:
-* secondary degenerative change | |- |Subcutaneous nodules | |Linear or nodular calcification in the subcutaneous and deep soft tissues may be seen, especially in the lower extremities | | |- |Osteoporosis |
-*Mostly due to [[glucocorticoid]] usage
-*Loss of height
-*Sudden back pain
-*Insufficiency fracture:
-** periosteal reaction progressing to callus formation in diaphyseal fractures
-** linear sclerosis and cortical thickening more frequent in metaphyseal and epiphyseal fractures | |Insufficiency fracture:
-* '''T1:''' low marrow signal
-* '''T2:''' high marrow signal with extension into adjacent soft tissues | |}
-==Key CT Findings in Systemic Lupus Erythematosus==
-==Examples of CT Findings in Systemic Lupus Erythematosus==
 ==References==